Japanese Society for Infection Prevention and Control-Online Journal

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An Outbreak of Norovirus Gastroenteritis in a Long-term Care Hospital: Relation with Tube Feeding

Kenji KONO¹⁾, Shigekazu MIYAJI²⁾, Machiko KAMURA¹⁾ and Kazumi KAWAKAMI³⁾
¹⁾Infection Control Department, Social Medical Corporation Taiseikai Fukuoka Kinen Hospital, ²⁾Healthcare Corporation Shunkokai, Shunkokai Memorial Hospital, ³⁾Graduate School of Healthcare and Nursing, Juntendo University

In December 2012, norovirus gastroenteritis outbreak occurred in a long-term care hospital. Thirty patients and fourteen healthcare workers developed the disease, and six patients died. The average age of the patients with norovirus infection was 82.0 years. Twenty-five patients (83.3%) had a cerebrovascular disease as the underlying illness. As for the level of care needed, 28 patients (93.3%) were classified above level four. As for the routes of enteral feeding, 26 patients (86.7%) underwent tube feeding, of whom 21 (70%) received percutaneous endoscopic gastrostomy (PEG) feeding. Out of the 30 infected patients, 16 (53.3%), 19 (63.3%), and 26 (86.7%) patients presented with a fever, vomiting, and diarrhea, respectively. Norovirus examination was carried out for 11 patients, with 6 patients showing positive results. All six deceased patients were bedridden and died because of aspiration pneumonia. The outbreak occurred in multi-patient rooms simultaneously and throughout the ward in a focused manner. Most infected patients needed high-level care because of stroke and received enteral feeding through PEG. Therefore, it was considered that norovirus might spread by hand contamination from vomitus erupted out of the PEG stoma. By binomial logistic regression analysis requiring long-term care 4 and 5, enteral feeding including PEG could be named as the independent risk factor. Thus, the stoma area of PEG should be kept clean, especially during the epidemic norovirus season. In addition, glove exchange and careful hand washing must be executed during PEG feeding and stoma care for each patient.

Key words：norovirus, long-term care hospital, requiring long-term care, tube feeding, percutaneous endoscopic gastrostomy

e-mail: kenzi.kono＠gmail.com

Received: January 18, 2020
Accepted: May 18, 2020

35 (4)：175─182,2020